Are Doctors Paying Attention to Women in Pain?

Women experience far more chronic pain and report their pain early and more often than men.

“Yet they are typically not believed and or treated by their healthcare professionals,” according to Cynthia Toussaint, a chronic pain sufferer and founder of For Grace, which sponsors an annual conference for Women in Pain in Los Angeles.

The CDC said in the Vital Signs report that nearly 48,000 women died from painkiller overdoses between 1999 and 2010. During that time, the number of fatal overdoses among women rose by 400 percent, compared to 265 percent in men

Toussaint has had Complex Regional Pain Syndrome for 30 years. She founded her organization in 2002 to raise awareness about the disease, and later included fibromyalgia and other over-lapping chronic pain conditions.

The “Women in Pain” topic is increasingly getting more attention from those who treat pain.

“The under treatment of women in pain is a huge concern,” says Dr. Dan Bennett of Denver, who is Chief Medical Officer for the National Pain Report.

Laurie Edwards recently wrote on the topic in the New York Times. Edwards is the author of the recently released book, In the Kingdom of the Sick: A Social History of Chronic Illness in America.

She thinks the whole issue of how people even describe their pain is too subjective.

“One person’s 4 is another person’s 10 and vice versa,” Edwards wrote. “So I think the inherent subjectivity of pain, as well as the inherent subjectivity of the health care professional, who is then interpreting your perception of pain, makes it incredibly challenging.”

For patient advocates like Toussaint, the answer is not more pills but better education.

“We need pain management training for healthcare professionals and the pharmaceutical industry needs to be held accountable for its part in this crisis,” she told National Pain Report.

CDC Director Tom Frieden, MD, believes opioid painkillers are being over prescribed and some doctors are not adequately trained on how and when to prescribe them. He counts himself as one of them.

“I can tell you that when I went to medical school the one thing they told me about pain was is if you give a patient in pain an opiate painkiller they will not become addicted. And that was completely wrong. So we have a real need to better understand and make sure we use them only when necessary,” said Frieden

“There’s things we can do to protect women and reduce the burden of prescription opiates, first is to ensure all health care providers women recognize can be at risk for prescription painkiller overdose, it’s not just a problem among men, which is how many think of it currently.”

Doctors tend to fall into the old thinking of the “hysterical female”. If a woman says she hurts and you can see no visible signs of injury or illness the woman MUST be depressed or just crazy. A man can walk into the office and be treated totally different. These physicians shy away from treating pain in any way they can but will throw antidepressants at you at for anything and everything. Here’s the thing… Antidepressants treat chemical imbalances that cause depression, not situational depression. For a chronic pain patient who has been living with pain for years and is depressed because of the pain, the way they’re treated by the medical community, how their lives have changed because of all of that, antidepressants will not work! There’s no chemical cause! Please, if you are a doctor reading this, stop treating chronic pain patients of all kinds like they’re crazy. It only makes things harder to bear.

As a woman dealing with chronic pain, it is has been very tough for me to get help. I had to write letters to get my doctor to listen to me and understand what I was going through a year ago. While I didn’t really want to lose my job because of my pain, I knew that if I continued doing what I was doing that I was doing myself a disservice. So I fought for what I thought was right. Of course, my restrictions ended up being too strict for my employer and I was let go from my job. Since then my pain as become worse and won’t get better until I make the decision to have surgery. I am currently taking pain meds, twice a day and some days it isn’t enough but I follow my dr’s strict orders on the medication because I don’t want to overdose. I have had three doctors refuse to give me a handicap sticker because they want me to keep walking even though walking long distances cause me additional pain. Not to mention I feel guilty for not being able to work and provide income for my family, I miss my old self and the things I used to do. I have turned into a homebody and would rather stay home than to go out and do things with my family, especially, if it involves walking. I don’t qualify for a scooter or mobility help at this time because I am still able to walk short distances without assistance.

AMEN to Dennis Kinch! There are many of us that depend on our pain meds in order to live and work. I’m a young parent and have many years of living ahead of me. I work hard, pay taxes, and volunteer. My meds keep me from becoming unemployed and a burden of the government. I’m tired of people taking away things that keep some of us going. I didn’t ask to be in chronic pain, to be constantly hurting and still trying to keep a smile on my face. Let me tell you, until a person is in chronic pain they have absolutely no idea what it is to live like people like me! I’m sick of the new regulations that have been placed on me getting my meds filled and I’m tired of the pharmacist giving me dirty looks. Mind your own business and I will mind mine!

Let’s see, 4800 overdose deaths by women a year…minus the suicides…minus the street recreational abusers…minus the ones who experienced untreated side effects from the prescribing doc…but even if it was 48,000 a year, it would pale in comparison to the millions whose lives are made better, who still work, who have good relationships, who still recreate, who still do the things that make their lives worth living, even with chronic severe pain. When will WE get the attention? When will the “do-gooders” stop trying to save us from ourselves and actually help us to become happier and more productive…and let us decide, as intelligent, thinking adults what’s best? Where’s the common sense?

THANK YOU for this excellent article. I’ve lived with pain for all my 61 years, and it has become increasingly difficult to manage. The meds that gave me a bit of help had unacceptable side effects so I’ve had to use them not at all, rarely, or in low doses to get some benefit which beats getting none. I’ve been blessed to have doctors who believe that I live with as much pain as I say I do, and I’ve had no problem getting opioids and other meds; yet my doctors have felt discouraged when they have tried everything they know to help me and failed or brought just a little relief. I have been unable to work or do much the past several years because of chronic severe pain, and because the meds that give a little help make it too hard to function adequately at any job. A huge barrier to overcome is insurance refusing to pay for sufficient physical therapy and other modalities to help me become and stay a lot more functional. Disability income is not sufficient to cover these expenses, so I’ve been going without and “paying the price” of that. So doctors and insurance companies must be much better educated about effective pain management and the urgency of helping patients receive it timely. Otherwise there are huge costs for the patients and their families; and insurance companies, instead of saving money, must pay much more as patients’ medical conditions escalate because of inadequate care.

This is what I have to say about the CDC report. The IOM report “Relieving Pain in America…” states there are three groups of people who are discriminated against when it comes to adequate pain management, WOMEN, the poor, and African-Americans.

It perplexes me that opioids are the big concern when the first drug used to treat women is antidepressants and psychoactive drugs, because after all, we are a stressed out lot in an emotional state, right?

Antidepressants are handed out like candy. I would argue that opioids are not, at least in my experience. The culture on managing pain has changed drastically over the past 5 years. Antidepressants interact with more medications, and when prescribed inappropriately, can increase the likelihood of suicidal ideation even when the patient wasn’t clinically depressed. One must bid the question, “Why are the effects of this classification of drugs not sensationalized, or considered?” “How many women were also on these meds?” “Where is the data collection tool for this classification of medications? They are not only expensive; they come with far greater consequences. They are not as effective as the pharmaceutical sales agent attempts to convince physicians, i.e. relieving pain and IMPROVING symptoms. There is an “under-recognized problem” on the effect of antidepressants, which completely restructure the brain.

In their own report, they say men are more likely to die from overdose, so we focus on educating women? Hey! Aren’t men important too? This reeks of bias, just as stated in the IOM report.

Statistics are just that, statistics. They can be skewed in data collection and study constructs. Pain is pain. The CDC only focused on “illicit” pain killers. I would argue that NSAIDS are abused because they are about all we have left to take, and they are equally life threatening. Where are the stats on those? We were given opioid receptors for a reason, and I would like to see the research move in that direction. We should be focusing on the patient.

Dr Bennett- call your colleagues and tell them to obtain adequate education in pain care. Its well known that lack of provider education is the major barrier to improving pain care. As Dr Volkow indicated Veterinarians receive 10X more education in pain care then do doctors. Doctors continue to oppose receiving education in pain care. This year a report on Opioid REMS indicated a 15% aadherence rate. Doctors have caused and continue to be the biggest cause of problems in pain care including the ignorant and careless use of opioids.

I was diagnosed one year ago with SpA. After a year of undiagnosed chronic pain and no answers. I am a 30 year old female and look to be healthy. I work full time and I’m a full time mother. The docs looked at me as a pill seeker. It was a fight to get a diagnosis. Having to fly down south for it (i live in Alaska). It was also scary because I had no idea what was a wrong with me and why I feel the way I do. They tell me that they do not want to prescribe pain meds for a chronic condition because then I will have an addiction on top of the disease. Some days I don’t know how I do it. I am slowly learning to smile through it as I am sick of people asking what is a wrong or how am I doing. I started off on a nsaid only with no luck. Now I am on biologic meds (enbrel) and a NSAID. Doesn’t seem to be doing it. My doc talked to me about cymbalta and told me to consider it because it is good for pain.. I went to do some research and found that people often have terrible withdrawal from that plus it has to be taken everyday verses pain meds that don’t need to be taken if not needed. This has been a very frustrating thing for me. From the beginning they have made me feel some type a way I can’t explain. I would not wish this on anyone but sometimes I wish they knew what it felt like on a day to day basis. Sorry for the ramble!

Excellent article. So much of getting adequate and thoughtful treatment for pain relies on finding the right physician. One that has experience with your symptoms, believes what you report and is willing to experiment until treatment is effective.

I was lucky to find such a physician, but it took a long time and I had to fire a lot of doctors along the way. The flip side is that I was completely honest and forthright with him also.

JOY
Co-author, with Dr. Steven Overman of You Don’t LOOK Sick! Living Well with Invisible Chronic Illness

I was thinking today, that perhaps newer technology can be used to manage pain meds more effectively, such as having the patient take a picture of the amount of pain meds they have left, along with a newspaper or something showing the date (or an electronic date stamp), maybe once in between visits. That way, the clinician can monitor how much of the medication is being used. I am wondering if others think this would be viable, or too intrusive, or too time intensive? Another thing that would help is to have some more coordination between specialists. At once point I had a psychiatrist prescribing a benzo and a sleep med, and pain doc giving pain meds, and before long, I had assembled a small pharmacy. That is dangerous, in my opinion.

In my personal experience it all has to do with where you live and whether or not you have insurance. When I lived in the DC area in the early to mid 2000’s and had insurance, I had no problem getting pain meds, though at the time, nobody had much luck figuring out where my pain was coming from, so I was diagnosed with Fibromyalgia. When I moved to Kansas City, in 2005, still with insurance, it took some phone calls and one false start, but I managed to find a pain management clinic. In fact, I was given what I now realize was a stunning amount of pain meds, which, fortunately for me, was not a problem for me. Then, in 2012 I moved to West Virginia, with the 2nd highest overdose rate in the country, and had no insurance for the first 5 months until Medicare kicked in. It was like pulling teeth to get pain meds, but I requested xrays of this body part, and that body part, until I had a full set of the pain areas, and took them to the doctor I had seen in NoVa. She then diagnosed all kinds of spinal arthritis, stenosis, facet syndrome, etc. But she didn’t feel comfortable prescribing on a regular basis so it was back to the chalkboard. But, I finally found pain specialist and hour and a half away, in Maryland. For me, pain meds are pretty effective, and I am going to be trying some procedures in the near future. However, I used to be a social worker so I am experienced in navigating systems and I am good at zeroing in on what is needed and persisting until I find it. For people, male or female, who are not that savvy or persistent, I think it would be very difficult. My question is, if overdose deaths are increasing in women, isn’t that a sign that they are getting more pain meds?